An Ounce of Prevention Is Worth a Pound of Cure

Foot ulcers are dangerous and painful, but simple relief can be obtained with therapeutic footwear, according to a recent study of patients with neuropathy and a history of previous foot ulcers.

Researchers in India studied 241 people attending a specialized foot clinic who have been diagnosed with diabetes for an average of 12 years and were considered to be at high risk for recurring foot ulcers. The researchers divided the patients into four study groups: three using therapeutic footwear and a group of 50 who used their own footwear.

One therapeutic group of 100 wore sandals with insoles made with microcellular rubber; a second patient group of 59 members wore sandals made with polyurethane foam; and a final group of 32 wore sandals with molded insoles. All the patients in the three therapeutic footwear groups demonstrated lower foot pressure (average score of 6.2 to 6.9) compared with the fourth (control) group score of 40.7. Moreover, the onset of new lesions in the fourth group was 33 percent, compared with just 4 percent in all other groups.

Use of therapeutic footwear can also reduce the amputation rate in the diabetes population as well as the onset of new ulcers, say the authors.

—Diabetes Care, February 2004

What is the take-home message of this study?

People with diabetes must be told by their primary care physicians, endocrinologists, diabetes educators and podiatrists that they may be able to prevent foot ulcerations by wearing appropriate shoes and insoles. Moreover, if they are not told, they must ask. Since ulcers are often precursors to infection and amputation, preventing ulcers can save limbs and lives. The right shoes and innersoles are one fairly simple step in the right direction.

What can people with diabetes do/where can they go to get these types of insoles?

The first place people with diabetes should go for advice about shoes, innersoles or any other foot-related issue is to their podiatrist. If they do not have a podiatrist they should find one. Podiatrists are trained to recognize current and potential foot problems and can advise their patients about appropriate footwear. People who have diabetes and who are also insured by Medicare should also ask if they qualify for the Therapeutic Shoe Program. This Medicare program pays for 80 percent of the cost of shoes and special innersoles for these patients. Certain qualifications must be met such as a foot deformity, poor circulation, prior ulcerations or neuropathy and calluses. Even if you don’t qualify for funding, buying quality shoes and innersoles may be one of the most important purchases you make. Look for a store with a certified pedorthist— a professional trained to fit your shoes properly.

Neil M. Scheffler, DPM, FACFAS
Baltimore Podiatry Group Baltimore, Maryland

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